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Research ArticleArticles

Intergenerational Transmission of Maternal Health

Evidence from Cebu, the Philippines

Leah E.M. Bevis and View ORCID ProfileKira Villa
Journal of Human Resources, September 2022, 57 (5) 1425-1465; DOI: https://doi.org/10.3368/jhr.58.1.0819-10372R2
Leah E.M. Bevis
Leah Bevis, assistant professor in the Department of Agricultural, Environmental, and Development Economics at the Ohio State University
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Kira Villa
Kira Villa, associate professor in the Department of Economics at the University of New Mexico ().
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  • Figure 1
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    Figure 1

    Marginal Effect of Maternal Health on Child Health across Ages

    Notes: This figure plots the marginal effects, estimated by Equation 1, of instrumented maternal height on child HAZ (Panel A) and WHZ/ZBMI (Panel B) at each observed age. Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. The estimated effect on birthweight is excluded from Panel B because its scale (grams) differs from those measured at other ages. Estimated coefficients corresponding to those in this figure are in Table 3. All pretreatment controls are included, which are mother age, mother age cohort dummies, child gender, child birth month fixed effects, and baseline and current barangay fixed effects. For birth outcomes only an indicator for whether gestational age is in question is included. Bars represent 95 percent confidence intervals.

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    Figure 2

    Marginal Effect of Maternal Health on Child Health across Ages, Controlling for Socioeconomic and Parental Input Controls

    Notes: This figure plots the marginal effects, estimated by Equation 4, of instrumented maternal height on child HAZ (Panel A) and WHZ/ZBMI (Panel B) at each observed age. Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. Circles correspond to the baseline estimates reported in Figure 1, Xs correspond to estimates from Equation 4 including pretreatment controls and only socioeconomic controls (Column 1 of Table 4), and iamonds correspond to estimates from Equation 4 including pretreatment controls and both socioeconomic and parental input controls (Column 2 of Table 4). The effect of maternal height on birthweight is excluded from Panel B because its scale (grams) differs from those measured at other ages. Estimated coefficients corresponding to those in this figure are in Online Appendix Table B.10. Bars represent 95 percent confidence intervals.

  • Figure 3
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    Figure 3

    Marginal Effect of Maternal Health on Child Health, Controlling for Socioeconomic Characteristics and Birthweight

    Notes: This figure plots the marginal effects, estimated by Equation 5, of instrumented maternal height on child HAZ (Panel A) and WHZ/ZBMI (Panel B) at each observed age. Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. Circles correspond to baseline estimates reported in Figure 1 and include only pretreatment controls. Xs correspond to estimates from Equation 5 and include birthweight in addition to all pretreatment, socioeconomic, and parental input controls. See Sections IV.A and V.A and Table 4 for details. The effect of maternal height on birthweight is excluded from Panel B because its scale (grams) differs from those measured at other ages. Corresponding coefficients are reported in Online Appendix Table B.12. Bars represent 95 percent confidence intervals.

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    Figure 4

    Marginal Effect of Maternal Health on Child Height-for-Age by Sex, Controlling for Socioeconomic Characteristics and Birthweight

    Notes: This figure plots the marginal effects, estimated by Equation 5, of instrumented maternal height on child HAZ at each observed age separately for girls (Xs) and boys (diamonds). Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. Controls include birthweight in addition to all pretreatment, socioeconomic, and parental input controls. See Sections IV.A and V.A and Table 4 for details. Corresponding coefficients are reported in Online Appendix Table B.15. Bars represent 95 percent confidence intervals.

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    Figure 5

    Marginal Effect of Maternal Health on Age 11 Girl Height-for-Age Depending Probable Growth Stage, Controlling for Socioeconomic Characteristics and Birthweight

    Notes: This figure plots the marginal effects, estimated by Equation 6, of instrumented maternal height on girl HAZ at age 11, separately for girls likely in childhood (Xs) versus pubertal growth (blue diamonds). Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. Girls are assumed to be in childhood growth if menarche is still two or more years after their 1994 interview date. Controls include birthweight in addition to all pretreatment, socioeconomic, and parental input controls. See Sections IV.A and V.A and Table 4 for details. Corresponding coefficients are reported in Online Appendix Table B.16. Bars represent 95 percent confidence intervals.

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    Figure 6

    Marginal Effect of Maternal Health on Age 15 Boy Height-for-Age Depending Probable Growth Stage, Controlling for Socioeconomic Characteristics and Birthweight

    Notes: This figure plots the marginal effects, estimated by Equation 6, of instrumented maternal height on boy HAZ at age 15, separately for boys likely in childhood (Xs) vs pubertal growth (diamonds) based on four pubertal indicators. Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. Details on the pubertal indicators can be found in Section III. Controls include birthweight in addition to all pretreatment, socioeconomic, and parental input controls. See Sections IV.A and V.A and Table 4 for details. Corresponding coefficients are reported in Online Appendix Table B.17. Bars represent 95 percent confidence intervals.

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    Table 1

    Summary Statistics for Time-Varying Characteristics

    Age 1Age 2Age 8Age 11Age 15Age 15
    Panel A: Girls
    Child age (years)

    1.01

    (0.01)

    2.01

    (0.01)

    8.51

    (0.04)

    11.55

    (0.40)

    15.09

    (0.35)

    15.09

    (0.35)

    Height-for-age z-score

    −1.21

    (0.98)

    −2.23

    (1.08)

    −1.99

    (0.95)

    −1.93

    (1.10)

    −1.83

    (0.80)

    −1.83

    (0.80)

    Weight/BMI-for-age z-score

    −0.57

    (0.79)

    −0.71

    (0.84)

    −0.81

    (0.84)

    −1.02

    (1.05)

    −0.67

    (0.99)

    −0.67

    (0.99)

    Stunted

    0.62

    (0.49)

    0.73

    (0.44)

    0.52

    (0.50)

    0.48

    (0.50)

    0.42

    (0.49)

    0.42

    (0.49)

    Wasted

    0.29

    (0.46)

    0.21

    (0.40)

    0.08

    (0.27)

    0.17

    (0.38)

    0.09

    (0.29)

    0.09

    (0.29)

    Per capital income (Philippine Peso)

    2,704

    (4,756)

    3,273

    (7,994)

    10,463

    (10,331)

    14,480

    (15,480)

    23,494

    (21,961)

    23,494

    (21,961)

    Household size

    6.69

    (2.81)

    6.73

    (2.74)

    6.86

    (2.24)

    7.06

    (2.40)

    6.95

    (2.41)

    6.95

    (2.41)

    Panel B: Boys
    Child age (years)

    1.01

    (0.01)

    2.01

    (0.01)

    8.51

    (0.05)

    11.53

    (0.40)

    16.12

    (0.33)

    16.12

    (0.33)

    Height-for-age z-score

    −1.41

    (1.02)

    −2.38

    (1.14)

    −2.08

    (0.94)

    −2.00

    (0.97)

    −1.87

    (0.86)

    −1.87

    (0.86)

    Weight/BMI-for-age z-score

    −0.58

    (0.89)

    −0.73

    (0.92)

    −0.81

    (0.94)

    −1.14

    (1.13)

    −1.01

    (1.07)

    −1.01

    (1.07)

    Stunted

    0.66

    (0.47)

    0.78

    (0.41)

    0.54

    (0.50)

    0.52

    (0.50)

    0.42

    (0.49)

    0.42

    (0.49)

    Wasted

    0.34

    (0.48)

    0.22

    (0.41)

    0.09

    (0.29)

    0.20

    (0.40)

    0.16

    (0.37)

    0.16

    (0.37)

    Per capital income (Philippine Peso)

    2,694

    (3,649)

    3,362

    (5,267)

    10,584

    (12,291)

    15,178

    (19,617)

    27,126

    (26,766)

    27,126

    (26,766)

    Household size

    6.92

    (2.82)

    6.88

    (2.77)

    6.91

    (2.28)

    7.11

    (2.46)

    6.75

    (2.44)

    6.75

    (2.44)

    • Notes: This table summarizes time-varying childhood characteristics across each observed age for girls (Panel A) and boys (Panel B).

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    Table 2

    Summary Statistics for Baseline Characteristics and Pubertal Indicators

    MeanSDMin.Max.
    Baseline
    Mother’s age26.805.8717.0047.00
    Mother’s height (cm)150.795.11128.80169.50
    Male0.530.500.001.00
    Birthweight (grams)2,997.31446.441,150.005,700.00
    Low birthweight0.120.320.001.00
    Girl indicators
    Age at menarche13.050.9810.2515.33
    Menarche four years or more after 1991 interview date0.720.450.001.00
    Menarche 2+ yrs post 1994 survey0.350.480.001.00
    Menarche 1+ yrs before 1998 survey0.840.370.001.00
    Boy indicators
    Begun shaving0.210.400.001.00
    Voice has changed in recent years0.950.220.001.00
    Has visible underarm hair0.610.490.001.00
    Has high level of pubic hair0.420.490.001.00
    • Notes: This table summarizes baseline characteristics and pubertal indicators for our sample of index children.

    • View popup
    Table 3

    Transmission of Maternal Health to Child Health

    (1)(2)(3)(4)(5)(6)
    Birth HAZAge 1 HAZAge 2 HAZAge 8 HAZAge 11 HAZAge 15 HAZ
    Panel A: Child Height Outcomes
    Mother’s height (cm)

    0.0206

    (0.0287)

    0.0931***

    (0.0202)

    0.134***

    (0.0343)

    0.128***

    (0.0304)

    0.147***

    (0.0290)

    0.109***

    (0.0239)

    Observations2,9882,9962,6042,2102,1332,045
    IV effective F-stat56.6862.2844.0433.0032.0122.66
    Birth WeightAge 1 WHZAge 2 WHZAge 8 ZBMIAge 11 ZBMIAge 15 ZBMI
    Panel B: Child Weight Outcomes
    Mother’s height (cm)

    30.38**

    (12.55)

    0.0764***

    (0.0227)

    0.0971***

    (0.0302)

    0.0768**

    (0.0311)

    0.0487

    (0.0377)

    0.0618*

    (0.0358)

    Observations299029802606221021332045
    IV effective F-stat56.7357.3544.4233.0032.0122.66
    • ↵Notes: This table reports marginal effects, estimated by Equation 1, of instrumented maternal height on child HAZ (Panel A) and WHZ/ZBMI (Panel B) at each observed age. Maternal height is instrumented using the SVA-optimal IV; see Sections IV.A and IV.B for details. These coefficients correspond to those plotted in Figure 1. Controls include gender, mother’s age, mother cohort dummies, birth month fixed effects, and baseline and current barangay fixed effects (which are equivalent at birth year). For birth outcomes only, an indicator for whether gestational age is in question is included. Child height outcomes are length-for-age z-scores from birth through age two and height-for-age z-scores for ages 8–15. Olea and Pfluefer effective F-statistics are reported. Clustered standard errors are in parentheses. *p<0.1, **p< 0.05, ***p<0.01.

    • View popup
    Table 4

    Socioeconomic and Parental Input Controls at Each Age

    Socioeconomic ControlsParental Input Controls
    (1)(2)
    BirthPer capita household income, Household size, Mother’s education, Baseline asset value, Access to piped water, Flushable toilet, Electricity, Garbage taken away after disposal, Uses clean cooking fuel, Food area kept clean, Excreta visible around HHTook prenatal vitamins, Received prenatal care, Baby delivered by doctor, Baby delivered in hospital
    Age 1Per capita household income, Household size, Mother’s education, Baseline asset value, Access to piped water, Flushable toilet, Electricity, Garbage taken away after disposal, Household uses clean cooking fuel, Food area kept clean, Excreta visible around HH, Animals kept inside HHIn last year child given vitamins or minerals, vaccinations, or nontreated water, Child breastfed for full first year
    Age 2Per capita household income, Household size, Mother’s education, Year 2 asset value, Access to piped water, Flushable toilet, Electricity, Garbage is taken away after disposal, Uses clean cooking fuel, Food area kept clean, Excreta visible around HH, Animals kept inside HHIn last year child given vitamins or minerals, vaccinations, or nontreated water
    Age 8Per capita household income, Household size, Mother’s education, Access to piped water, Flushable toilet, Electricity, Garbage taken away after disposal, Uses clean cooking fuel, Food area kept clean, Excreta visible around HHSince last survey child given vitamins or minerals or vaccinations, Child given worm medication, Child’s food consumption score for average week, Extended family in HH
    Age 11Per capita household income, Household size, Mother’s education, Access to piped water, Flushable toilet, Electricity, Garbage taken away after disposal, Uses clean cooking fuel, Food area kept clean, Excreta visible around HHParent usually helps child with homework, Hours spend on chores in avg week, Child’s food consumption score for average week, Extended family in HH, Per capita expenditure on food, child allowances, and school fees
    Age 15Per capita household income, Household size, Mother’s education, Access to piped water, Flushable toilet, Electricity, Garbage taken away after disposal, Uses clean cooking fuel, Food area kept clean, Excreta visible around HHChild’s food consumption score for average week, Extended family in HH, Per capita expenditure on food, child allowances, and school fees
    • Notes: This table lists all socioeconomic and parental input controls included at each observed age when estimating Equations 4, 5, and 6. Controls differ across ages because (i) survey questions differed across rounds and/or (ii) certain inputs are important at one age but not another (for example, help with homework). Measures on food area cleanliness and visible excreta around household (HH) are based on enumerator observation.

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Journal of Human Resources: 57 (5)
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Intergenerational Transmission of Maternal Health
Leah E.M. Bevis, Kira Villa
Journal of Human Resources Sep 2022, 57 (5) 1425-1465; DOI: 10.3368/jhr.58.1.0819-10372R2

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Intergenerational Transmission of Maternal Health
Leah E.M. Bevis, Kira Villa
Journal of Human Resources Sep 2022, 57 (5) 1425-1465; DOI: 10.3368/jhr.58.1.0819-10372R2
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  • Article
    • ABSTRACT
    • I. Introduction
    • II. Background on Maternal Health Transmission and Child Growth Trajectory
    • III. Data
    • IV. Identifying Maternal Health Transmission
    • V. Exploring Persistence and Mechanisms of Transmission
    • VI. Conclusion
    • Footnotes
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